Pain behaviours in Extremely Low Gestational Age infants

Area of Science:

• Neonatal pain assessment
• Infant behavior
• Physiological responses in neonates

Background:

• Limited validated pain measures exist for extremely low gestational age (ELGA) infants (<28 weeks GA).
• Existing infant pain measures rarely include preterm infants, especially ELGA infants.
• Lack of reliable indicators hinders clinical interpretation of pain in immature neonates.

Purpose of the Study:

• To evaluate physiological, behavioral, and biochemical responses to painful and non-painful procedures in ELGA infants.
• To investigate the influence of gestational age and sex on pain responses in ELGA infants.

Main Methods:

• Prospective crossover study of 50 ELGA infants in a Canadian NICU.
• Standardized painful (heel lance) and non-painful (diaper change) procedures were used.
• Continuous monitoring of physiological (heart rate, oxygen saturation) and behavioral (facial, body movement) indicators, plus salivary cortisol measurements.

Main Results:

• Four specific facial actions (brow bulge, eye squeeze, nasolabial furrow, vertical mouth stretch) reliably indicated pain after heel lance.
• No significant changes in physiological measures or cortisol levels were observed post-heel lance.
• Increased body movements during diaper changes may reflect immature motor coordination in ELGA infants; no differences found based on gestational age subgroups or sex.

Conclusions:

• Facial action changes are the most sensitive indicators of procedural pain in ELGA infants.
• Specific body movements (e.g., hand-on-face, fisting) warrant further investigation for pain assessment in ELGA infants, potentially complementing measures like NIDCAP.
• Current findings emphasize the importance of facial cues for pain identification in the most premature infants.